book review: how medicine gets better

I just listened to the audiobook of Better, by surgeon Atul Gawande (capably narrated by John Bedford Lloyd). Gawande explores how behavioral innovation and medical organization improve medicine at least as much as scientific discovery. In his advice on being a positive innovator in the conclusion, one item that impressed me was his counsel to count something. “If you count something you find interesting, you will learn something interesting.”

Here is the summary of my thoughts on the book, posted on Amazon:

fascinating exploration of past and present improvements in medicine from behavioral innovation rather than scientific discovery

Gawanda is a surgeon and a skilled writer. This collection of essays explores the ways in which changes in medical behavior and organization (as opposed to new scientific discoveries) can lead to drastic improvements in health and survival. He explores a broad array of applications, from interminable efforts to eliminate polio in India and elsewhere to impressive innovations in front-line war medicine in Iraq to ways that hospitals have tried to get doctors to … wash their hands. Even though many of the essays were previously published (in the New Yorker), Gawanda has updated them and integrated them into the broader theme of the book.

Some of the essays stray from that theme, such as the one discussing medical malpractice, but each one is engaging. Gawanda is excellent at writing for a lay audience: I have no medical training and found the book completely accessible.

One of the principal messages, introduced early and revisited often, is that of “positive deviance”: the idea that wonderful changes come from identifying (and learning from) individuals who deviate from norms and achieve impressive results. In his conclusion, Gawanda gives some ideas for becoming a positive deviant in medicine and in life. One is to “count something,” building on the book’s examples in which measurement systems led to drastic improvements in performance: one example is the Apgar score for newborns; another is the publication of cystic fibrosis treatment performance across hospitals around the country. Gawanda goes on to give a compelling example of how his own measurement helped him understand how to reduce sponges getting left inside patients.

The audiobook published by Sound Library consists of 6 CDs (about 7 hours and 30 minutes). It has good, engaging narration by John Bedford Lloyd.

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